Strokes and more Flashcards
Types of stroke (4)?
Ischemic - embolic, Ischemic - thrombotic, Hemorrhagic, Lacunal
SSx of Embolic Stroke?
Rapid onset, maximal in several seconds
HA on affected side, focal seizures
Pre-existing mitral stenosis, A fib, MVP, endocarditis
SSx of Thrombotic Stroke?
Onset few minutes-hours, progressive over days-weeks
MC cause atherosclerosis
Associated Dx: HTN or excess Tx of HTN, DM, CAD, PVD, head trauma, Post-MI, post-heart block, post-shock, post-surgical anesthesia
What’s the MC vessel involvement for a Thrombotic stroke?
Middle Cerebral Artery
SSx of Hemorrhagic Stroke?
Brain parenchyma cause: HTN or drug use (ASA or blood thinners)
Subarachnoid cause: aneurysm
Onset: less abrupt than embolism, evolves over 1-2 hours
SSx: HA, vomiting, ALOC
Where is a Lacunal Stroke?
Small vessels & areas
What is the acute management of stroke? Including difference in management of hemorrhagic vs. non-hemorrhagic?
ER (to specialized stroke capable hospital) Maintain open airway Hydrate w/IV fluids (nothing PO) Control HTN Tx existing CV or systemic dz
Hemorrhagic: neurosurgeon repair of vessel bleed ASAP
Non-hemorrhagic: get anticoagulation on board w/in 1-2 hrs of onset: Heparin followed by Warfarin (INR 3-4.5)
What are 4 systems to watch during the recovery phase of stroke and why? How to Tx?
Respiratory! d/t complications from resp. depression/failure –> Tx with oxygen replacement & CPAP for apnea
Urinary/Digestive control! Watch for urinary retention –> secondary info, urinary/fecal incontinence, fecal impaction
CV: metabolic rehab: monitor all the things (lipids, LpA w/fibrinogen, Homocysteine, CRP, bleeding time, BP control, NT, hormone balance
What kinds of therapy and/or specialty services should be on board after stroke?
Physical therapy for exercise rehab (PT 3 x week x 1 year)
Speech therapy
Occupational Therapy (ADLs)
Counseling (grief, life restructure)
Home health assistance/nurse if needed
Social services, social worker (economic stressors, insurance, service navigation)
What are some special equipment needs to consider after stroke?
Wheelchair, transfers, accessible shower/toilet, doorway remodels, lifts/ramps - all occupational therapy
Naturopathic Tx for stroke recovery?
PEMF Hyperbaric Oxygen: 1.6-2 atm 1-2 x day Oxygen multistep therapy Chelation: oral/IV Constitutional Hydro (home) Homeopathic Rx Scalp needling
